NPIMap

Individual provider Active NPI

Paul Ryan Lane, PA-C

  • Physician Assistant
  • Mount Vernon, IL
National Provider Identifier
1962023820
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.007905 Issued in IL
Practice address
4101 N Water Tower PL
Mount Vernon, IL 62864-6296
Phone
(618) 244-6222
Fax
(618) 246-1247
NPI assigned
May 1, 2020
Sex
Male
Sole proprietor
Yes

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deaconess Illinois Crossroads Inc 7 clinicians

Practice addresses (Care Compare)

1209 W Robinson St
Wayne City, IL 62895-9672
Phone (618) 895-2050

Hospital & facility affiliations

  • SSM Health at Home Health-Illinois Home health agency, Mount Vernon, IL, CCN 147088
  • LHC-Illinois Home Health Care Home health agency, Marion, IL, CCN 147716
  • Mederi Caretenders Home health agency, Mount Vernon, IL, CCN 147251
  • Deaconess Illinois Crossroads Hospital, Mount Vernon, IL, CCN 140294
  • Good Samaritan Regional HLTH Center Hospital, Mount Vernon, IL, CCN 140046
  • Fairfield Memorial Hospital 1 Hospital, Fairfield, IL, CCN 141311
  • SSM Health St Mary'S Hospital -Centralia Hospital, Centralia, IL, CCN 140034
  • Heartland Regional Medical Center Hospital, Marion, IL, CCN 140184

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20200929001344 IL Practitioner - Physician Assistant 3870912611 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.007905ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Illinois Crossroads Inc CurrentSince Jan 14, 2023 Accepting new patients
Deaconess Illinois Crossroads Inc Single Specialty PastSince Dec 6, 2022 Accepting new patients

Locations

4101 N Water Tower Pl
Mount Vernon, IL 62864
Phone (618) 244-4313

209 Crossroads Pl
Ste 150
Mount Vernon, IL 62864
Phone (618) 244-6222

Interoperability endpoints

  • Direct secure messaging: paul.lane.1@27782.direct.athenahealth.com
  • Direct secure messaging: plane422451@direct.deaconess.com

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X 085.007905 IL Primary

Addresses

NPPES NPI Registry

Primary practice location

4101 N Water Tower PL
Mount Vernon, IL 62864-6296

Mailing address

4101 N Water Tower PL
Mount Vernon, IL 62864-6296
Phone (618) 244-6222

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 18, 2020.

{
    "created_epoch": "1588291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1962023820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 N WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646296",
            "telephone_number": "618-244-6222",
            "fax_number": "618-246-1247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 N WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646296",
            "telephone_number": "618-244-6222",
            "fax_number": "618-246-1247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "PAUL",
        "middle_name": "RYAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-05-01",
        "last_updated": "2020-12-18",
        "certification_date": "2020-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.007905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

Verify at the official NPI Registry.